A new lease on life for children with TB meningitis

As part of his doctorate in Paediatrics, Dr Ronald van Toorn, a Senior Specialist in Paediatric Neurology at SU and Tygerberg Children's Hospital (Western Cape Government Health), explored ways to improve the outcome of childhood TB meningitis. This severe form of tuberculosis in children occurs when TB bacteria invade the membranes and fluid surrounding the brain and spinal cord. It is the most common type of bacterial meningitis in the Western Cape with an average of one case being reported at Tygerberg Children's Hospital every week.

Van Toorn says it is difficult to diagnose and treat TB meningitis and the optimum choice, dose and duration of treatment is not known. He adds that while the World Health Organisation recommends a treatment period of one year for the disease, children admitted to Tygerberg Children's Hospital are treated for six months on higher dosages of TB drugs.

Van Toorn conducted a four-year study with 184 children with TB meningitis to determine whether this treatment is safe and effective. He found that after treatment was completed, 80% of the children had a good outcome and the mortality rate was 3.8%.

"The mortality rate of 3.8% is the lowest in the world for the treatment of childhood TB meningitis."

Van Toorn says all the children were followed up for a period for two years after treatment completion to see whether the TB recurred.

"There were no relapses. Our results are the best in the world. No other hospital where children have been treated for TB meningitis has had the same success."

Van Toorn says another reason for the positive results is that they have developed unique ways of treating the complications of the disease which include fluid in the brain, inflammation of blood vessels and eye nerves and brain abscesses.

"After replacing some of the spinal fluid with air so that the brain cavities show clearly, X-ray of the brain is taken to determine where in the brain the blockage of spinal fluid is. The study showed that 80% of children with TB meningitis can be treated with medication and do not require brain surgery." 

Van Toorn says that while most children with TB meningitis also require steroids to reduce the amount of inflammation caused by TB germs, some children, especially those that develop brain abscesses and inflammation of their eye nerves, need stronger anti-inflammatory drugs than steroids.

He found that one such drug, thalidomide, was very effective in treating brain abscesses and inflammation of the eye nerves that causes blindness.

"Children with TB meningitis respond very well to thalidomide treatment and often the brain abscess disappears without damage to surrounding areas. Thalidomide also rapidly reduces the inflammation of the eye nerve and within days children who are completely blind regain full vision."

Van Toorn says thalidomide was banned during the 1960s because it caused limb deformities in children born to mothers who took it to treat morning sickness during pregnancy.

He adds that further studies in some parts of the world showed thalidomide's effectiveness  against certain cancers and skin conditions.

"Today it could prove the difference between life and death for many children with TB meningitis."

Van Toorn says the next step is to see whether thalidomide could also prevent inflammation of blood vessels and injury to the brain in these children.

Source: Stellenbosch University